Yesterday I spoke with 500 medical educators who are responsible for educating more than 26,000 medical students across 44 medical school campuses in the United States. Before my presentation, I asked 500 medical students: What are 3 things you’d like to tell your dean (but are afraid to say)? I’ll do it for you.
Here’s the basic message I delivered to a room full of medical school deans, provosts, presidents, and administrators in my keynote, Humanizing Medical Education: How To grow A Happy Doctor.
Isn’t it amazing that we know how to perform lung transplants, map the humane genome, grow organs in laboratories, but we don’t know how to grow a happy doctor? We do know how to grow unhappy doctors. Here’s what a medical student named Sam wants you to know:
1) Med school is the single most unhealthy thing I have ever done for my body, mind, and spirit.
2) I was on zero psychiatric medications and now I am on more than one, and it’s my second year of med school.
3) The only communication the administration has with us is through fear mongering and the upperclassmen just tell us to get through it and it’ll be over soon.
I’ve heard from lots of medical students like Sam. So I synthesized all the responses I received from students into the top 10 commandments for medical school educators. Yes, this is what medical students want to tell you but are afraid to say.
The 10 Commandments for Medical Educators
1) Teach leadership, transformation and empowerment in the curriculum. Empower me so I can empower patients.
2) Stop creating an environment that encourages competition among students.
3) Tell me that it’s okay to cry in front of patients if it’s on their behalf.
4) Ask what inspires me and ask how you can help me achieve my goals.
5) Respect us as adult learners. Avoid condescension. Don’t revel in our ignorance. We want to learn. Try not to kill our curiosity.
6) Advocate for humane treatment of attendings. So many docs have Stockholm syndrome, and see themselves as strong and capable, while seeing med students as whiny lazy kids who need to grow thicker skin. They need to be cared for and educated so that they see themselves as survivors of abuse—and empowered to break the cycle of abuse.
7) Be more concerned about your students wellbeing than damn Step 1 scores.
8) Provide emotional support for doctors and med students. Our wellbeing benefits the whole system. We are not the enemies here.
9) Please don’t train me to forsake my humanity to be a better doctor. My humanity should be celebrated, enhanced, and matured, not demeaned, degraded, or insulted.
10) Show me empathy.
What happens when medical training fails to follow the sage advice of these students? More of this:
Pamela Wible, M.D., is a family physician who is determined to stop the medical culture of bullying, hazing, and abuse that has injured countless medical students, physicians, and patients. Want to help? Contact Dr. Wible.
Short of starting an “Ideal Medical School” to go with your Ideal Medical Care, have you considered starting some sort of website where people could review and rank medical schools in terms of how well they adhere to your ten medical educator commandments? Then prospective students could decide to go to schools that are doing a good job in terms of caring for and supporting students. I realize the whole system needs reform but it would be a place to start, to at least show there is demand for better schools. It would also be interesting to read a blog post about a medical school that is doing things right, or at least mostly right. Is there one in this country?
Excellent ideas! I met with about 40 student affairs administrators today who are working on some very innovative programs to help medical students. I encourage them to do public forums among students and have them design their ideal medical school and then implement as much as possible. Always best to study successful programs and replicate those. Great idea about the website. Definitely would love somebody to do that. I don’t have any staff. Not able to do that now. Maybe you know someone who can begin to have students rank schools online. I know many osteopathic schools are on the right track with humanizing their culture. Will write more on this for sure.
Excellent 10 Commandments .
Thank you for taking this leadership on behalf of students .
There is an epidemic trend out there that needs to be cooled down NOW .
I am feeling extremely lucky to have attended medical school at McGill University in Montreal where the students were seen as adult learners, given respect, a huge amount of responsibility, and really celebrated. I think we could look to this institution and its leaders as guides in how to create happy physicians. At my recent 25 year reunion I was struck by the vitality and LACK of burnout in my classmates. It exists! Don’t re-invent the wheel.
AWESOME!! Yes! Let’s replicate what McGill University is doing right!
Sounds very reasonable.
Do you follow Dr. Peter Breggin’s, “How Do Psychiatric Medicine Really Work”…should be taught in all clinical programs and with patients as well:
So pleased to see the “industry” taking note of your work.
As someone who finished medical school in 1989, it seems as though I may have just gotten lucky; it was ok. Even Residency was ok. Things became nasty once I began life as an attending and had the chance to work alongside the “survivors” of abusive training programs.
Besides asking the schools to change, perhaps the students could gain immediate benefit from mindfulness or meditation training. There ongoing study at the VA comparing the value of “talk therapy” to meditation for our servicemen and women struggling with PTSD.
While it’s somewhat of a different subject, meditation training for the medical students would not only enhance coping, but could offer academic benefits as well. Calming the mind, following the breath is step one when anything starts to derail….
I’m all for the benefits of meditation. To quote my TEDMED talk: “So how do we stop institutional abuse? Physician suicide hotlines inside our hospitals? Resilience training for our wiped-out doctors? Meditation classes for medical students? Wait, is our goal to help victims cope with abuse? Or to end the abuse?: Read full transcript here: https://www.idealmedicalcare.org/blog/tedmed-talk-why-doctors-kill-themselves/
Thank you for your good work, it still seems to me the industry is owned by pill shills and administrative folks who at least to me are the equivalent of skimmers. Its a for profit system, you cant fix greed, WHO has the U.S. health care system pegged.
I wonder how many gifted healers have been forced to drop out of Medical school due to being compassionate and passionate. True reason can’t exist without passion. And it’s only logical that lack of sleep will ultimately result in malpractice. Why hasn’t this issue been addressed so long ago?
Good question! Fear-based tactics have been used far too long to maintain the current flawed reductionist medical model which is the basis of western medical education. Many gifted healers leave medicine. Some walk away. Some by death.
How to grow a happy doctor ? This question always in my mind because in fact there is egoism individualism to system for learn to prepare someone become a doctor. Whose duty ? Lecturer ? Campus ? Dean of the Faculty of Medicine ? Government ?
Make a great team for healing anybody and make healthy generally.
This is also true of Social Workers. The gold standard is if you make it through the torment you get the degree….not if you would make a good therapist or Case Manager. It’s cruel and pardoxical.Learn to take care of others by being treated sadistically. And unapologetically.
One of the best written documents and so much more eloquently put then I could ever state. My shitty former med school could learn a lesson or two from this. There is a reason so many bright students quit med school where I came from and a lot of it had to do with the debasing, degrading, inhumane treatment of medical students
It’s 2016. Western med schools are based on a 17th century philosophy of reductionism (viewing people as machines). Time to evolve. We need a holistic medical education that honors the minds, hearts, and souls of our medical students, doctors, nurses—and patients. How does that sound?
Hi there Dr. Wible,
My name is Sam and I’m also a second year medstudent, although not the one you mention in your story. I had one comment and one question:
Comment: I have been fortunate in my medical school’s tacit and occasionally open acknowledgement of the pressures its students face, but you’re right, many students are not so lucky. Maybe it’s because I’m in a West-Coast school, and trying to provide help to students is a more accepted stance by the powers-that-be in this culture than in perhaps other institutions? I just wanted to relate that there is definitely a range of experiences in this regard.
Question: Do you have any suggestions for schools trying to humanize undergraduate medical education, while still preparing students for the reality of internship/residency and afterwards practice as a full attending? Or should this “jump” be left to residencies?
Yes! Definitely a range of experiences. Some very progressive schools out here in the west. I do hear more horror stories from those in east coast urban schools. I think undergrad schools should follow the same guidelines listed here and also emulate the schools that have happy successful students. We should be measuring these things and also make the information available to applicants so they can choose a school based on mental health factors not just test scores and academic success.
My wife has given up nearly everything to become a doctor and ascended after leaving her family behind in a far away country to great heights here in the US. Tragically, since matching into one of the US “top 20” residency programs she has been bullied, discriminated against, harassed, remediated and continually cycled over and over as the program attempts to “find the right data” to “hang” her from. Trouble is she does extremely well when treated fairly and given an opportunity to sleep. So the program draws out her remediation and shoves her into inhumane conditions, ridiculous pimping while sleepless etc manufacturing bad evals to help cycle her back into the hell again. Its clear the Program Director wants her to quit or die. And the “board” advising her future does the bidding of the Program Director.
Since she had literally given up nearly everything and worked tirelessly over the past 17 (after already having an MBA) she is tenacious to beat this thing… but its really killing us, and they act meaner still when they smell blood. Its honestly disgusting.
We have filed complaints and grievances at the institution at all levels and it just goes no where. People admit she has been treated unfairly but can’t do a thing. Even our lawyer is afraid to take on the institution.
Anyhow, as a husband and caregiver I want to save both of us from this horrible situation. As it seems in this great country there really is no justice when it comes to medical training.
We need to get her transferred into a caring program as a PGY2 or PGY3 (she already should have graduated). She has plenty of supportive attendings who know her work well and think highly of her. How in your best estimation can one find supportive programs that could take such a transfer? The program director some time ago actually recommended her to one of the most notorious NY IM programs for suicide! So we need help… is there a list? Is there a person/institution that can help for placement to literally save a life??? This is a serious request… any help/referral is graciously accepted.
One thing I forgot to mention:
She is a graduate of a very good very supportive US medical school.